S263 Clinical Implications of Alcohol-Related Liver Disease in Patients With Choledocholithiasis: A Retrospective National Study

Introduction: Choledocholithiasis is a common hepatobiliary condition requiring hospitalization and often associated with significant complications. Alcohol-related liver disease (ALD) may predispose patients to worse outcomes. This study aimed to evaluate the impact of ALD on in-hospital outcomes among patients admitted with choledocholithiasis. Methods: We conducted a retrospective cohort study using the National Inpatient Sample from 2019 to 2021. Adult patients with a diagnosis of choledocholithiasis were identified using ICD codes and stratified based on the presence or absence of ALD. Demographic and clinical characteristics were compared between groups. Multivariate logistic regression was used to identify independent predictors of in-hospital mortality and complications. Results: Among 19,023 hospitalized patients with choledocholithiasis, 431 (2.3%) had a concurrent diagnosis of ALD. Patients with ALD were younger (mean age 57.8 vs 61.9 years), more likely to be men (64.0% vs 36.2%), with longer hospital stays (6.3 vs 4.9 days) and higher mean total hospital charges ($82,760 vs $70,152). ALD patients had higher rates of in-hospital mortality (3.94% vs 1.52%), malnutrition (11.4% vs 4.9%), sepsis (12.1% vs 7.8%), acute kidney injury (29.2% vs 17.2%), encephalopathy (10.9% vs 4.8%), pancreatitis (6.7% vs 1.0%), and hyponatremia (26.2% vs 9.3%). On multivariate analysis, ALD was independently associated with increased odds of in-hospital mortality (odds ratio [OR] 3.34, P < 0.001), sepsis (OR 1.47, P = 0.01), acute kidney injury (OR 2.12, P < 0.001), encephalopathy (OR 2.73, P < 0.001), and pancreatitis (OR 3.91, P < 0.001). Additional independent predictors of mortality included malnutrition (OR 3.43, P < 0.001), hyponatremia (OR 1.73, P < 0.001), and hypertension (OR 1.53, P = 0.01). Conclusion: Alcohol-related liver disease is associated with worse in-hospital outcomes in patients admitted with choledocholithiasis, including increased mortality and in-hospital complications. Early identification of these high-risk patients may help guide timely interventions and improve clinical outcomes.